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Food superstars come and go. One minute something is going to cure all of your ills and the next minute it might be considered poison (lets just hope that chocolate and wine stay on the beneficial foods list)!
Vitamin D has been on the ‘hero’ list for years, but has been all over the headlines recently.
You might have seen the teasers:
“Low levels of this vitamin are tied to more severe respiratory infections…tune in at 6 to learn which one.”
With recent studies being touted, we thought this would be a good time to take a deep dive into this important vitamin.
For many years, vitamin D deficiency was most associated with Rickets (a disease that causes very soft bones.) But recent studies found that vitamin D levels are also very important well beyond good bone health.
Deficiencies are associated with multiple illnesses including diabetes, cancer, heart disease…. It’s important to note that we are talking about associations, not causations. It’s not yet been shown, for example, that vitamin d supplementation could actually change your heart disease or cancer risk.
Researchers are exploring the link between low levels of D and obesity. There are ongoing studies underway to see if there is a link between low vitamin D levels and increased allergies. Other studies are associating vitamin D deficiency with insomnia and mood disorders. There have also been studies linking vitamin D and cognitive health in older folks. This list goes on and on.
Dr. Nayana Anne, a board certified Integrative Medicine Doctor at Getzwell Pediatrics in San Francisco is a big fan. She highlights that it has been explored as a possible adjunct in some patients with ADHD, particularly those with deficiency. Vitamin D has the potential to improve neurotransmitter regulation, cognitive function and treatment response to other ADHD medications.
She also uses it for her patients who suffer from migraines. Anecdotally they appear to have a reduced number of attacks with lower severity when supplementing with vitamin D.
Dosing and Recommendation
Vitamin D is measured in international units (IU). The American Academy of Pediatrics recommends that all babies start getting 400 IU daily.
Note: there are 2 forms of vitamin D - D2 and D3. Most experts are in favor of focusing on D3, which is the more natural form. D2 is less stable and less clinically useful in humans.
American infant formulas are fortified to include vitamin D3. Babies who get 32 ounces of formula per day have their needs covered. So, as long as they are on full formula you don’t need to worry about it, but combo feeding with breastmilk and formula might not be enough to meet daily needs.
If your baby is breastfed, that is a different story. Unfortunately, the segment of the population who often test the lowest for vitamin D are pregnant and breastfeeding women.
It would be nice to believe that breast milk is a “complete source” for all of your baby’s needs, but with vitamin D this is not necessarily the case. If you are a nursing mom and you are deficient, your baby is simply not getting the amount that they need from your milk. If mom has a good level, her milk might be adequate but there are no good reasons to take a chance.
There are some studies that claim that if a nursing mom takes 6,400 IU/daily, this can adequately fortify the milk and ensure that the baby is getting the suggested amount of 400 IU.
But be careful because 6,400 IU daily is much higher than the recommended daily dose, so make sure you’re calculating where else you’re getting it from. It can add up if you are getting it from multiple sources. If you get close to 10,000 IU daily, you may be approaching toxic levels, enough to cause calcium overload and kidney dysfunction.
Giving vitamin D drops directly to the baby can take the guesswork out of this and remains the AAP recommendation.
Vitamin D Brands
There are many different brands available for your baby. If you are giving your baby a multivitamin supplement like Poly-Vi-Sol, that already has the D in it. If you are giving the D alone, one of the most common brands is the Enfamil D-Vi-SOL. One dropper is 1 ml; this gives the daily dose of 400 IU. Babies seem to tolerate this well.
There are some other forms out there that give 400 IU in each drop! That is quite a difference. It is essential that you be a careful label reader! Dr. Ted likes Wellements or Baby D drops because they’re organic, and it’s easier to use one drop that you can put right on the nipple prior to putting the baby on the breast.
Yes, we have gotten calls from parents absolutely freaking out because they don’t recall being told about this when their babies were newborn.
There is a lot that goes on during the first couple of visits and it is easy enough for things to get overlooked.
If you are just hearing about this for the first time and your baby missed the first few months, please don’t stress. Vitamin D crosses the placenta and hangs around for 2-3 weeks after birth, so if you were on a prenatal vitamin, your baby likely did get some from that.
Because vitamin D is fat-soluble and stored in the body, it’s important not to megadose with supplements—but the amounts typically recommended are very safe.
On the other hand, be assured that you cannot get “too much” from natural sources such as the sun or diet.
It’s not just babies who need it
Getting Vitamin D is not just a recommendation for newborns; it is a lifelong health issue.
Children over the age of one, and all adults, should make sure they are at the very least getting 600 IU daily. The recommendation increases to 800 IU for adults over 70 to support bone health and reduce fracture risk.
Dr Anne likes Pure vit D. One drop is 1,000 IU. It has excellent absorption compared to other forms because it bypasses the GI tract. Take after a fatty meal for best results.
There are also yummy gummies that are 1,000 units if that is the easiest way to get your kid to cooperate.
Although the recommendation is for 600 IU daily, we have no concerns of bumping the dose up to 1,000 IU, as this is still well within the tolerable safety window for 6 months and older.
Why are so many of us deficient?
At the same time that scientists were recognizing the importance of Vitamin D, they were also discovering that many folks are deficient without even being aware of it.
Historically much of our vitamin D is/was from sun exposure.
Honestly the biggest shift is that human no longer live outside like our earlier ancestors! It turns out that roofs are more convenient (they block the rain, etc…) but they also block our access to the optimal amount of sun exposure.
The rays of natural sunlight that produce vitamin D in your skin cannot penetrate glass. This means you can’t get vitamin D from indirect sunlight in your car or at home.
Folks who live in sunny climates generally have higher levels. Darker pigmented skin has a harder time absorbing it. Some dermatologists think that being out in the sun unprotected for 30 minutes, 2 or 3 times a week, would probably give most people the amount they need, but this depends a lot on latitude, season, how much skin is covered by clothing, time of day, etc.
What impact does sunscreen have? Not as much as you might think. If sunscreen were applied *perfectly* it would in fact block the skin’s ability to produce vitamin D. To apply it appropriately, you need to apply liberally, evenly, and reapply every 2 hours. However, most real-world observational studies of this in humans show that we are too ineffective at thoroughly applying sunscreen to make a clinically meaningful difference in vitamin D production.
Some exposure is healthy, but overdoing it is problematic. It is hard to find a balance. Sunburn and an elevated risk of skin cancer don’t seem like a sensible answer, when there are so many easy ways to take a supplement.
Checking Vitamin D Levels
It isn’t a bad idea to know what your level is. The next time you are getting routine blood work, consider asking your doc to add an order for the vitamin D level. The recommended test usually ordered is a 25-hydroxy vitamin D level. There is some debate about what the proper level should actually be, but most people seem to agree that:
< 12ng/mL is severely deficient (measurement is nanograms/milliliter)
12-20 ng/mL is still not adequate
20-50ng/mL is a reasonable range of normal
>75ng/mL is the level where many naturopaths recommend you to aspire to. There might be something to this. Some of the recent studies on vitamin D and respiratory tract infections (referenced above) show a significantly lower risk of severe disease at this level when compared to people with less than 15 ng/mL
Be aware! 40% of folks tested in this country are low!! Please make sure that you and your baby are not one of those.
Special Considerations for Bone Surgery
Dr. Nicole Cates is an amazing podiatrist in San Francisco. Because she deals with bones and fractures, she takes vitamin D very seriously and checks the levels of all of her pre-op patients. She also checks their parathyroid hormone and calcium, as they’re closely related to vitamin D and bone health.
She was kind enough to share the following slide:
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It’s worth noting that the vitamin D level needed for elective bone surgery here may be higher than the average person needs in everyday life.
So here is a public service announcement, if you are having any upcoming orthopedic procedures, or dental implants, it may be even more important to pay attention to your vitamin D levels.
Natural sources
As you can see from the chart below, milk that has D added, some fatty fish, and cod liver oil are on the short list of good dietary sources for vitamin D, but a person would have to drink four tall glasses of vitamin D fortified milk each day just to get minimum levels of vitamin D into their diet, which is still a lot of milk.
Other foods like some mushrooms and eggs will get you a bit, but not enough to begin to make a dent in the daily requirement:
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Note: some farmed mushrooms can be intentionally exposed to UV light to increase vitamin D levels, but mushrooms produce the less useful D2 form of Vitamin D, making it not as reliable when compared to other sources.
Without exposing yourself to sunshine it isn’t so easy to get adequate amounts without the help of a supplement!
But what about the recent headlines? Is there actually anything new?
Yes. Kind of.
The conclusion from the recent research is that higher vitamin D levels are indeed associated with a lower risk of severe acute respiratory tract infections. The study was a large-scale meta-analysis using more than 36,000 participants.
Bottom line, to no one’s surprise, low levels are associated with worse outcomes. High levels are associated with better outcomes. There isn’t robust data for outcomes with “normal” levels, such as those from 20-75, as described above, so we don’t know either way.
But there is so much tantalizing research going on about Vitamin D as an option for immune system health, that we couldn’t stop ourselves from going down lots of rabbit holes (other people get coffee, we look at data).
There was a lot there.
Why Might Vitamin D Be So Helpful, Molecularly?
At a cellular level, vitamin D seems to play a quiet but meaningful role in how our immune system responds to respiratory infections.
Studies show that immune cells lining the airways convert vitamin D into its active form. When vitamin D is present and activated, these cells increase production of antimicrobial chemicals which can directly disrupt viruses and bacteria.
Vitamin D also seems to help fine-tune the immune response, dialing down excessive inflammation while preserving the parts of the immune system needed to clear infection.
Together, these effects have led researchers to hypothesize that adequate vitamin D levels may not prevent respiratory infections outright, but could help reduce their severity by strengthening first-line defenses and limiting the kind of runaway inflammation that makes illnesses like the flu or RSV feel so miserable.
It looks promising. We speculate that future headlines may tout more definitive benefits.
Concluding Thoughts
While the study making the headlines only looks at correlation, it certainly doesn’t hurt to make sure our babies and families are getting enough, especially with flu and other respiratory illnesses circulating.
Of course Vitamin D is no magic bullet! (Both of us still do take it daily) But if taken in safe doses it is associated with good health with very little downside.
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